Dental Board of California
Licensing details for: 101275
Name: BARADARAN, SAM
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address not disclosed
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: LAKE BALBOA DENTAL GROUP PRACTICE OF SAM BARADARAN DDS, INC
License/Registration Type: Fictitious Name Permit
License Number: 16453 Primary Status: Current - Active
Address :
16440 VANOWEN ST
VAN NUYS CA 91406
LOS ANGELES COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: LAKE BALBOA DENTAL GROUP PRACTICE OF SAM BARADARAN DDS, INC
License/Registration Type: Fictitious Name Permit
License Number: 16453 Primary Status: Current - Active
Address :
16440 VANOWEN ST
VAN NUYS CA 91406
LOS ANGELES COUNTY
